Iain Morgan, PhD
There are now 3 main head and neck cancer tumor types in relation to HPV16 genome status—integrated only, viral episomal only, and viral-human hybrid episomes—according to a report published in Oncotarget.
The results suggest that the viral-human hybrid episomes have been previously miscategorized.
, co-lead author Iain Morgan, PhD, a member of the Cancer Molecular Genetics research program at VCU Massey Cancer Center, discusses research that redefines HPV-positive head and neck cancer and may also identify new therapeutic targets.
OncLive: Can you please discuss the rationale behind conducting this research?
In cervical cancer, it’s been quite clear that the integration of the lateral genome into the host results in a worse outcome for the patient. In head and neck cancer, there was very little research done on this. For example, if you look at the literature, there’s been an acceleration of research and interest in this field over the last 5 years. Prior to that, there was only a low number of publications but in the last 5 to 10 years, that has increased.
However, more work needs to be done to prove this research.
What are the next steps planned for this research?
One of the questions that we're asking ourselves as we look at the literature is what is a simple test that we can do to tell us what is an integrated tumor since they have worse outcomes.
For the other 2 tumor categories, the outcomes for these patients tend to be the same, which needs to be investigated further.
To determine if a virus integrates, it’s important to look for E2 or RNA. Usually when the virus integrates, it loses its target of downstream viral genes, meaning E2, E4, and E5, are not expressed in a truly integrated tumor. The RNA should not be there, even if the DNA is there.
What we've developed in the lab is a fluorescent RNA probe against E2 to detect E2 RNAs in that approach. At VCU, we’re going to go back retrospectively in tumors and do that RNA probe to look for the ones that don’t give us a signal. You can check with one of the viral oncogenes, like E6 and E7, to make sure that the virus is being expressed.
We’re looking for tumors that are E6-positive or E7-positive. We are predicting that patients with E2-negative at an RNA level are going to have worse outcomes.
This research is important because there is a huge number of clinical trials now focused on de-escalation therapy. Patients who have HPV-positive tumors have better outcomes with chemoradiation therapy but it tends to be in the younger patients. The radiation is damaging, leaving patients with no saliva glands and dental problems. This is leading clinicians to want to give these patients a lower dose of chemoradiation if they respond well, which seems to work for most patients
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